Cancer, which is a combination of over a hundred diseases, is one of the most feared if not the most feared disease in the world today. It has become more of a household name rather than a disease; jealousy is like a cancer, bitterness is like a cancer and many more comparisons are common phrases. This however is not just a trend but it’s a reflection of the massive impact that cancer has had on the society. In the United States, cancer is the second most common cause of death and is only second to heart disease accounting for almost 25% of all deaths in the country. This is a very disturbing statistic taking to account that cancer takes time before it takes toll on the victim. This begs the question, what is cancer and more specifically what is breast cancer?
Cancer is an abnormal growth of cells which is caused by multiple changes in gene expression leading to dysregulated balance of cell proliferation and cell death (Ruddon, 2007). These cells can spread to other parts of the body through the blood and lymph systems. The formation of the abnormal cells emerges from the normal formation of new cells to replace worn out cells in the body. The cancer cells however do not get worn out but keep on multiplying as indicated in figure 1 and become more than what the body needs thus forming a tumor or a growth which maybe a lump or thickening of the skin (Peacock, 2002). The tumor can either be a benign tumor which once removed does not grow back or a malignant tumor which are actually cancer. Malignant tumors are composed by unusual cells which divide without control and can penetrate and destroy tissues around them (Peacock, 2002). A malignant tumor that emerges from the breast is what is called breast cancer.
According to the American Cancer society, breast cancer can be defined as a malignant tumor that starts in the cells of the breast. Women are more vulnerable as compared to men though men can also get breast cancer too. Most breast cancers begin in the cells that line the ducts (small tubes that carry milk from the lobules to the nipples). There is also a possibility of cancer starting in cells of other tissues of the breast though this type of cancer is usually considered to be dangerous and is usually referred to as sarcomas and lymphomas. Once cancer develops in the breast it may spread to other parts of the body through the lymph system.
There are several types of cancer which affect women but some of them are more prevalent than others. Ductal Carcinoma in situ, Invasive ductal carcinoma, Invasive lobular carcinoma and Iflammatory breast cancer are the most common types of cancer. The Invasive ductal carcinoma is the most common type of invasive cancer, accounting for 8 out of 10 cases of invasive cancer.
The effects of cancer and the lack of cure for the disease when it reaches a certain level of growth has been an issue over the years. Though the statistics indicate a consistent decrease in the number of cancer incidences since 1989, the most significant drop was in 2002-2003 period where the number of incidences dropped by 7%. This was mostly attributed to the reduction in the use of menopausal hormone therapy (MHT). The number of new infections is however still high with American Cancer Society estimating that 232,670 new cases are expected to be diagnosed among women in 2014 and 2,360 new cases among men. The numbers of deaths are also still high with the total being 40,430 in both men and women. Moreover, the economic impact of the disease is still high with National Institute of Health (NIH) estimates settling at $86.6 billion in direct medical costs and $ 130.0 billion for indirect mortality costs totaling to $216.6 billion. This is a massive deflation to the economy which is still struggling to regain its lost glory.
This paper seeks to analyze Breast cancer from its first recorded incidents in the pre historic period and walk through the journey of the diagnosis and medical advancement concluding with a discussion on the responsibility of the society to the affected individuals.
HISTORY OF BREAST CANCER
Breast cancer dates back as far as the prehistoric and ancient world period. Though researchers believe that the impact of the disease was not as massive as it is today as it is a disease of maturity. Evidence of breast tumors can be traced as early as 3rd millennium BC where The Edwin Smith Surgical Papyrus is believed to contain the first reference to breast cancer (Winchester, 2006).
The Greek and Roman Period (460 BC – 475 AD) provide very vivid incidences of breast cancer. The early civilization of the Greeks provided the most complicated medicines and surgery of the time and it’s no surprise that they discovered the main symptoms and effects of breast cancer from diagnoses, development to death. Physicians of the period provided clear accounts of breast cancer and had various vocabularies to define the components. Karkinoma referred to a malignant growth, Scirrhous reffered to a particularly hard tumors while Cacoethes referred to a probable or early malignancy (Winchester, 2006). Roman Physician Aulus Cornelius Celsus and Hippocrates (460 – 375 BC) of the Corpus Hippocraticum were very influential in their contribution during the period.
The period of renaissance which was between sixteen to eighteenth century introduced more detailed study of breast cancer. The works aimed at improving or disapproving the middle age developments of Galen and Avicenna. During this period the surgeon’s journal in France published Henri Ledran’s thesis that suggested that breast cancer had a local origin (Winchester, 2006). John Hunter who is referred to as the father of investigative surgery conceived that coagulation of the lymph was responsible for carcinoma of the breast. This was further advanced by Boer-haave who postulated that liquor nervorum was a probable instigator of breast cancer. Another important contribution during this period was Nicolaes Tulp who noted that ‘the sole remedy is a timely operation’ (2006).
The nineteenth century is probably the most influential year in the diagnoses and treatment of breast cancer. The advancements in the surgical field were very crucial in ensuring safe, pain free and successful operations were a common phenomena. As a matter of fact all of the current technologies used in the treatment of breast cancer other than chemotherapy were developed during this period. The development of the microscope under the leadership of Johannes Muller was a major breakthrough as this led to the discovery that cancers were composed of living cells. It’s during this period that two of the most crucial development in the treatment of cancer were advanced, the x-rays and the discovery that breast cancer was hormone dependent. The discovery of x-ray by Wilhelm Conrad Rontgen formed the basis for radiotherapy and mammography.
The twentieth century can be referred to a period of advancements and improvements in the various methods that were developed in earlier years. During this period mammography and chemotherapy were given more emphasis as radical surgeries were discouraged. The period experienced more investment in the research as western world recognized cancer as a major challenge to the well being of the citizens. In this period screened mammography was introduced an advancement that has been very handy in the diagnosis and treatment of breast cancer. Another important development was the discovery of hereditary transmission of the disease. The development in understanding and treatment of the disease can be simply be termed as mind blowing however the cause of cancer has still remained an enigma.
Symptoms of Breast Cancer
The most common symptom of breast cancer is a lump in the breast or nearby armpit which is a symptom for both sexes. In its early stages, the lump is not painful but may cause some discomfort (Ogden, 2004). However in a more advanced stage, there is a high probability of it being painful and feels as though it is fixed to the overlying skin (2004). It is however important to note that most breast lumps are not cancer. They are actually benign breast tumors which do not spread to other parts outside the Breast.
A change in nipple or breast appearance is also a probable sign of breast cancer. Any unexplained change in the size or shape of the breast should be a cause for alarm. Dimpling anywhere on the breast or unexplained shrinkage of breasts or unexplained swelling of the breast are symptoms that individuals should observe. A recent asymmetry of the breasts should be a reason to get checked though it’s common for women to have one breast that is slightly larger than the other. A nipple that is turned slightly inward or inverted or the skin of the aerola, nipple or breast becoming scaly, red or swollen or a pitting that resembles the skin of an orange are all probable symptoms of breast cancer. Nipple discharge that is either clear or bloody is another symptom of breast cancer (Krans, 2014).
Causes of Breast Cancer
There are various causes of breast cancer which have been fronted but there are two well researched and proven causes of breast cancer, hereditary and radiation ( Peacock, 2002). Other than these two there are estrogen, environmental causes and diets.
Hereditary – An individual who is born with mutated or damaged genes causes 5% to 10% of breast cancer cases. This is usually caused by the breast cancer genes Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA 2) which are supposed to stop tumor growth being abnormal.
Radiation – Breast cancer caused by radiation is as a result of individuals being exposed to high doses of ionizing or electrically charging radiation which has been proven to increase the probability of contracting cancer. This is evidenced by the high cancer rates among atomic bomb survivors and uranium mine workers.
Environment – Though not yet proven, this is one of the main causes of new cancer cases. Chemicals that are used in factories, farms and those contained in the household products are a probable cause of breast cancer. Pesticides that are commonly used to kill bugs, fuels, detergents, plastics that contain drinks or are used in homes may damage breast cancer genes which eventually lead to breast cancer.
Estrogen – This is the female hormone that is produced by ovaries. This type of hormone triggers the development of breasts and regulates the menstrual cycle. This is usually the period between one menstruation and another. The estrogen increases the number of cells in the breasts during this period and probably may stimulate the growth of breast cancer cells too.
Diet – This has been the focus for recent studies of cancer. The types of food that individuals eat have an influence on the probability of getting cancer later in life. For instance the consumption of foods with high fat raises the level of estrogen in the body thus raising the probability of contracting cancer. A study in Japan indicated that women typically eat less fat as compared to women in United States and Canada thus resulting to lower rates of breast cancer.
Types of Breast Cancer
Breast cancer is quite complex and is made up of 4 main types whereby two of them are more common. The two common types are ductal carcinoma and lobular carcinoma. The two can be either invasive or non invasive. Ductal carcinoma is found on the lining of milk ducts while lobular carcinoma just like the name suggests is found in the lobules. Lets take a more detailed analysis on the various types.
Ductal Carcinoma In Situ (DCIS)
This is the second most common type of cancer accounting for 20% of all new cancer cases according to the American Cancer Society. DCIS means that abnormal cells start in the cells lining the ducts without invading the walls of the duct into the tissue of the breast. Since the cancer cells have not grown through the duct wall, the cancer cells do not spread to lymph nodes or other organs thus why nearly all women diagnosed with this type of cancer are successfully treated.
Lobular Carcinoma In Situ (LCIS)
This is usually referred to as a pre cancer condition and is rarely shown by mammogram. It is usually discovered when examining other breast lumps. However if it is noticed early enough, the cells grow through the lobules into nearby lymph nodes or other parts of the body. The difficulties in noticing it leads to it constitute only 10% of all breast cancer cases.
Invasive Ductal Carcinoma
This is the most common type of cancer in the USA today and constitutes almost 80% of all invasive breast cancer cases. It starts from the cells lining the ducts and breaks through the wall of the duct and it also invades the tissue of the breast. It is actually the most common cause of a lump that is felt in the breast (Peacock, 2002).
Invasive Lobular Carcinoma
It starts from the lobules and grows through the walls into the lobules from which it spreads to nearby lymph nodes or other parts of the body. This type of cancer more often than not leads to thickening of breast tissue.
Other these four main types of cancer, there are other types which are less common but still form a legible percentage of the breast cancer cases. These include, inflammatory breast cancer, triple negative breast cancer, paget disease of the nipple, phyllodes tumor, and angiosarcoma.
THERAPY OF BREAST CANCER
As the saying goes, ‘prevention is better than cure’ and for a dreaded disease such as breast cancer the saying cannot be clearer. There are number of practices and exercises that need to be taken so as to reduce the probability of contracting the disease though there is no sure way of preventing it. This can be through regular physical activity, reducing your lifetime weight gain by eating fewer calories, regular exercising and limiting or completely avoiding alcohol intake. For women who are at an increased risk, there are specific tests that you need to take so as to be on the safe side. Genetic testing can be used to test whether a woman has certain mutated genes that are linked to breast cancer. Taking of drugs such as tamoxifen and raloxifene will go a long way in reducing the risk (Peacock, 2002). Surgery is also an option for the individuals whose probability is almost one. The surgery will remove either the breasts or the ovaries.
Another preventive measure that individuals can undergo is screening for breast cancer. In this case, screening means tests and exams that are used to find a disease like cancer in people who do not have indicate any symptoms. This procedure is actually recommended by the American Cancer Society. One of the tests used is mammogram which is an x-ray of the breast which uses very small amounts of radiation. Clinical breast exam which involves the examination of an individual’s breasts and the area under the arms by a health expert is also used for screening (Peacock, 2002). Breast awareness and breast self exam is another tests that can be used as means of screening. Finally, MRI is the fourth tests that can be carried out to test for any traces of cancer in the breasts. This test uses magnets and radio waves to produce very detailed cross-sectional images of the breast.
If an individual notes symptoms of breast cancer, he or she should see a doctor as soon as possible whereby the doctor may conduct a number of tests to determine the level of cancer in the breast. The main tests that are used are mammograms, MRI of the breast or the Breast ultrasound. The breast ultrasound uses sound waves to outline a part of the body. This method is very useful in unclear cases as it differentiates between a cyst and a tumor (solid mass). If a doctor confirms the existence of cancer, he or she recommends a biopsy.
A Biopsy is a test that is carried out when other tests indicate traces of breast cancer. The test involves removal of cells from the area of concern so that they can be studied in the lab. There are several types of biopsies that are carried out. The biopsy can either be a Fine Needle Aspiration (FNA) which uses a very thin hollow needle to pull out fluid or tissue from the lump. Core Needle Biopsy is another type of biopsy. This type of biopsy uses a larger tissue than the FNA so as to extract one or more cores of tissue. A third type of biopsy is the Vacuum-assisted biopsies which are done with systems such as mammotome under the guidance of a mammogram (Ogden, 2004). The final type of biopsy is the lymph node biopsy whereby a doctor removes cells from a swollen lymph node usually found under the arm. If the biopsy indicates presence of cancer, the treatment starts right away.
The treatment of cancer is usually a very complex and sensitive process since unlike other diseases, the body’s immune system cannot get rid of any traces of the cancer cells if they are not fully removed. The most common form of treatment is the surgery since the most efficient way of eradicating cancer is by removing the cancerous cells. The surgery can either be a breast-conserving surgery (BCS), Mastectomy, lymph node surgery or a reconstructive surgery (Ogden, 2004).
Radiation therapy on the other hand uses high energy rays or particles to kill cancer cells. This treatment may be either through external beam radiation or Brachytherapy. Another common of treatment is chemotherapy which is the use of cancer killing drugs either through shots in the vein or taken as a pill or liquid. Other forms of treatment are hormone therapy, targeted therapy and bone directed therapy.
THE PSYCHOLOGICAL AND SOCIAL RESPONSIBILITIES
Greg Anderson in his book identifies the human mindset as very powerful tool especially after diagnosis (2011). This is actually the case as there is a medical counselor who was quoted saying that when a family member is diagnosed with cancer, the whole family becomes sick . This is however not the mindset or approach that individuals who actually have breast cancer or are affected ought to have.
Through his work at Breast Cancer Charities of America, Anderson has understood the psychology of women who thrive following a breast cancer diagnosis (2011). The first step is believing in the body’s ability to heal, this not only helps one to regain full health but also acts as an everyday source of motivation. It actually enhances self confident and believes in one’s ability. The women also regain a sense of control over their lives which leads them to be personally accountable for the breast cancer recovery program. This strengthens them psychologically as they feel they are still capable of doing all the things that they were doing prior to the diagnosis.
Another interesting change that occurs is the spiritual awakening. The individuals are suddenly aware and recognize the most important values and aspirations which they have suppressed for a long time (Anderson, 2011). They channel their passion and effort not to their careers or jobs but to what matters most which is the health of oneself. Lastly, they become more aware of the community whereby the diagnosis brings about a special connection with the society. This case study drives at one thing which is creation of health and a health environment. This is the role of the society, creating a healthy environment whereby the survivors of breast cancer feel part of but not special members of.
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